Structural threat as a theoretical driver of trans health inequities.

Transgender and nonbinary (trans) people in the United States are increasingly exposed to structural conditions that undermine their safety, belonging, and inclusion. Existing theoretical frameworks focus on how anti-trans stigma and discrimination impact health, but structural drivers of trans health inequities remain undertheorized. This paper introduces Structural Threat to explain how cultural, legal, administrative, and institutional systems destabilize and withdraw social safety and protection for trans communities. Structural threat places trans people in a constant state of uncertainty, driving health inequities via weathering processes. We situate Structural Threat within established frameworks of the structural production of health inequities, including Fundamental Cause Theory and social determinants of health frameworks. Our analysis attends to how intersectional structural oppression shapes both exposure to structural threat and its health consequences with disproportionate effects for trans people of color. Conclusions highlight implications for research, policy, and practice that promote safety, belonging, and inclusion to reduce trans health inequities.